Mental Health Court Helps Save a Troubled Talent

SAN FRANCISCO — Kim Knoble’s past tracks an arc of promise, mental illness and descent into what her parents call “living hell.” But Knoble is not homeless, in prison or dead — outcomes common with stories like hers.

Instead, on Wednesday, the woman with a head of wild red curls plans to walk into the St. Francis Yacht Club, tell her tale of recovery and lift the instrument she did not touch for a decade to play Massenet’s “Meditation From Thais.”

Now 31, Knoble was mastering Mozart violin concertos by the time she hit middle school. As a high school senior, she played with the San Francisco Symphony Youth Orchestra — while doubling as concertmaster of its Marin counterpart.

Then, on a music scholarship at UC Irvine, her brain began to change.

She thought the FBI had tapped her phone, that Hollywood producers were sending her messages. She started using drugs. Years of difficulty followed: Hospitalization. Rehab. Relapse. Tough love. And homelessness.

What brought Knoble redemption was the crime she would commit. Agitated and off her medication two years ago, she pushed a 75-year-old man down the stairs of a city bus. He was injured. She was arrested.

But Knoble was fortunate. She was accepted into San Francisco’s Behavioral Health Court, which in lieu of incarceration offers comprehensive treatment, housing, vocational services and more under the supervision of a Superior Court judge.

That judge — Garrett L. Wong — will be among those cheering Knoble at the court’s 10th anniversary celebration Wednesday. Introducing her will be David Chiu, president of the San Francisco Board of Supervisors and a violinist who was among a chain of community members who helped place the instrument in Knoble’s hands a year ago.

“It felt,” she said, “like I had my soul back.”

Knoble’s family moved to Marin County’s Mill Valley when she was 3. With her older sister, she spent hours at San Francisco’s Fisherman’s Wharf while their father, photographer Dickran Knoble, and mother, Elaine, sold their art.

Her parents soon split, and her mom married Michael Tugendman, a jeweler who brought lively political discussion to the home. Knoble picked up a violin in fifth grade and took to it instantly. By high school, with $2,000 saved from baby-sitting, she bought a treasured instrument from world-renowned violin maker Roland Feller.

Though her grades were not stellar, she won a full music scholarship to UC Irvine. “She was so musical,” professor Haroutune Bedelian said. “Music was part of her.”But by her sophomore year, Knoble was drinking, taking drugs and entering a realm of psychosis.

“She called me one day and said, ‘When I fell as a kid and hurt myself, where did I hurt myself?'” Elaine Tugendman recalled.”Your leg,” her mother answered, baffled, and Knoble retorted, “No. It was my head, and you’re not my mother.”After she attempted suicide, the family brought her home. It was, Knoble said, “when the beginning started — of everything.”

During a monthlong hospitalization, Knoble was diagnosed with severe bipolar disorder. She took up with gang members and began using amphetamines. She was on and off her meds, in and out of rehab.

Once, after she followed a boyfriend to San Francisco, she called home and vowed to kill herself, believing “everyone” had eyes on her. When her parents alerted a city mental health team, Knoble cut her parents off.

She landed on the streets of San Francisco’s Tenderloin for a year. The family filed missing persons reports, but when Knoble was located, she often rejected their overtures. Her social worker at Citywide Case Management searched too.An exhausted Knoble finally begged her mother to help her get a hotel room and they made a deal: Knoble’s Social Security checks would go to her mother. Each time she showed up at Citywide to take her medication, she’d get $10. It seemed to work.

But two years ago, Knoble felt so good she stopped the meds. Within three days, her thoughts were racing, paranoia rising. Four days later, on a crowded bus, a man elbowed her as he headed for the exit. She pushed. He fell out the open door and cracked his head.

She was charged with felony elder abuse and was looking at prison time when her public defender mentioned Behavioral Health Court.

To qualify, a participant’s mental illness must be severe and the crime linked to it. The commitment to accepting treatment is key. Knoble’s victim did not object. She would get help and, if she stuck with it, keep her freedom.

There are an estimated 44 mental health courts in California, and the Judicial Council’s Administrative Office of the Courts has encouraged each county to adopt the model. A 2010 study examined San Francisco’s court and three others nationwide and found success. Though San Francisco’s served the highest proportion of participants with schizophrenia and the greatest percentage who committed crimes against people rather than property, it showed the greatest drop in rearrests compared with control groups — 39% to 7%.

San Francisco Public Defender Jeff Adachi said that before this program, released offenders might have to wait 45 days for follow-up appointments, by which time “they were back in jail.” In contrast, he said, Behavioral Health Court offers a seamless handoff from jail psychiatric services to outside helpers.

Skepticism initially ran high, but Adachi said he now considers it “one of the most successful start-up social experiments in criminal justice history.” Dist. Atty. George Gascon called it “a national model for its humane approach to treating clients who suffer from severe mental illness. We’ve enhanced public safety by reducing recidivism.”

Knoble has been sober for more than a year. She began to thrive after her diagnosis was changed — to schizoaffective disorder — along with her medication.

“I’ve had a lot of people over my shoulder,” Knoble said. As for Wong, “If I don’t make appointments or I’m slipping he lets me know. It’s encouragement, but firm encouragement.”

Knoble had sold her violin for drug money years ago. She missed the music.

A friend of Michael Tugendman’s suggested he ask the head of North Beach Citizens, which assists the homeless, whether they knew anyone with a violin to spare. She forwarded the email to volunteer Michael Moylan. He and his wife, Tina Moylan, have both lost siblings to mental illness.”We couldn’t save our own family members,” she said. “so when we get a chance to help others … we’re there.”

The couple knew Chiu played violin, so they turned to him; he called the San Francisco Symphony, and soon its education department had bought Knoble an instrument.

At City Hall last October, they presented it to her. “I could tell she was reconnecting with something very special to her,” Chiu said.

“When I lost music … I just lost that whole part of me that made me feel whole,” Knoble said. “I felt like my dreams were going to be able to live again.”

Twice weekly, Wong’s courtroom sheds its rule-bound state and fills with cheers when clients do well, gentle chiding when they don’t.As Knoble has progressed, her court check-ins have gone from once a week to every six. On Thursday, she addressed Wong with a cheerful “Hi!” “You’re looking very healthy,” Wong responded. Knoble has lost 120 pounds over the last year, thanks to the medication shift, sobriety and five hourlong walks per week with friends.

She was accompanied by Deputy Public Defender Jennifer Johnson, who has guided the project since its inception. Johnson told Wong that Knoble would graduate from the program next month, and Johnson would seek to have her felony reduced to a misdemeanor. There is no guarantee — the prosecutor has resisted a proposal for Knoble’s early release from probation — but Knoble is optimistic.

She had just made her first $50 restitution payment — with $14,950 to go — and a day earlier met with her caseworker to discuss a return to school to learn computer skills. Next month, she will speak at a public library about stigma.

She lives with roommates — all with mental health disorders — and practices regularly with a string quartet of women from Narcotics Anonymous. “I’ve never been better with myself,” Knoble said.

Elaine and Michael Tugendman, meanwhile, are launching a nonprofit called SomeonesDarling.org to give back to all the organizations that worked on a shoestring to “save her life.” “All these people in the street, they all have families,” he said. “I will never look at people the same way again.”

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